Pneumonia DSA Flashcards
What mechanisms of spread can cause pneumonia?
Which is the most common?
-
1. Descend from oropharynx => LRT
- 90% of the time
- Inhalation of viruses
- 3. Hemotogenously (staph)
- 4. Direct infection
What is the most common cause of CAP?
Streptococcus pneumonia
What are risk factors for pneumonia?
- Alterations in anatomic barriers
- Damaged cell-mediated or humoral immunity.
What are other common bacterial pathogens for CAP?
- H. influenzae
- Atypical pathogens:
- Mycoplasma pneumonia,
- Chlamydophila pneumoniae
- Legionella
- _______: comorbidities and extended care faciliy residents
- ________: alcoholism
- _____: structural lung disease
- ______: after ABX therapy
- _____: after hospitalization
- _______: aspiration
- Gram - bacteria
- Klebsiella
- Pseudomonas aeruginosa
- Pseudomonas aeruginosa
- Pseudomonas aeruginosa
- Enteric gram (-) and anaerobic organisms
What viral pathogens can cause pneumonoia
- Influenza
- Parainfluenza
- Adenovirus
- RSV
What virus can increase the chances of a NL healthy person to secondary invasive infections with pneumococcal or methicillin resistant Staph auerus pneumonia, causing Increase morbitidty and death during epidemics/pandemics?
Influenza
How can we prevent pneumonia?
- Influenza vaccine for all ppl older than 6months.
- Oseltamivir and zanamivir in an unvaccinated high-risk person during influenza epidemia.
- PPSV23 to prevent pneumococcal bacteria and meningits in healthy, immunocompetent adults (all over 65 and under 65 who live in long-term care places who have have CAD, COPD, alcohoslism, cirrhosis, etc and immunocompromised)
- PCV13 for all adults 65 & older and pts that are [immunocompromised, aspleic, CSF leaks, cochlear impants].
How are pneumococcal vaccines administered?
- NEver had vaccine: PCV13 is given first; PPSV23 8 wks later
- -If already given PPSV23; give PCV13 1 year after.
Pneumonia should be considered in what patients w what sxs?
- Cough
- Sputum
- Fever
- Chills
- Dyspnea
What is CURB-65 severity score for whether you should admit someone or discharge pt with pneumonia; what scores are necessary?
- Confusion
- BUN >20 mg/dL;
- RR >30;
- BP (systolic <90 or diastolic <60)
- Age 65 y/o or older
*Each worth 1 point –> 0-1 = outpatient; 2 = moderate/severe - short hospitalization; 3-5 = severe pneumonia/ICU
What are 3 Abx options for Mycoplasma pneumoniae?
- Macrolides
- Tetracyclines
- Fluoroquinolones
How do we treat patient in OUTPATIENT setting without CP disease or other comorbidities?
Macrolide or doxycycline
How do we treat patient in OUTPATIENT setting WITH CP disease or other comorbidities?
-
Respiratory quinolone
- or
- B-lactam + macrolide/doxycycline
What provides coverage for atypical organisms?
Macrolide, quinolones and doxycline
For the emperic tx of commuity acquired pneumonia what is first drug you should consider using in an ambulatory patient; what if they can’t tolerate this first lin drug?
- Macrolide = 1st
- Can’t tolerate –> go with Doxycycline
For the emperic tx of commuity acquired pneumonia what are 2 options for pt at increased risk for drug resistance (Abx in past 90 days, immunosuppression, exposure to kids)?
- Fluoroquinolone
- Macrolide + beta-lactam
For the emperic tx of commuity acquired pneumonia what should you give to hospitalized pt?
- FIRST: Supplimental O2
- THEN: IV ABX within 6 hours of arrival
- Respiratory quinolone
- B-lactam + macrolide/doxycline
- IV hydration
What should we give for patients when aspiration is suspected
- Clindamycin
- B-lactam/B-lactamase inhibitor (ampicillin-sulbactam, piperacillin-tazobactam)
What type of pneumonia patients require ICU?
- Severe pneumonia who have increased risk for death
- Respiratory failure who need mechanical ventilation
- Septic shock
- How long do we treat pts with mild-moderate CAP?
- Legionella?
- Pts with severe illness, empyema, lung abscess, meningitis, infection with P. aeruginosa/S. aeurus?
*
- 7 or less days if good clinical outcome, no fever for 48-72 hours, no extrapulm infection
- 5-10 days if quinolone is used
- 10 or more days
How does treatment differ if pt has S. aeurus pneumonia vs. uncomplicated bactermic pneumococcal pneumonia?
- S. aureus: 4-6 weeks of therepy and test for endocarditis
- -7-10 days
In hospitalized illness, when do we switch from IV ABX to ORAL?
- Once sx improve
- no fever on 2 occasions 8 hours apart
- can take meds by mouth
What can be given to patients to speed recovery and minimize complications of CAP?
1. Beta agonists via hand-held nebulizer
2. Chest physical therapy
OMM
What is healthcare-associated pneumonia (HAP)?
Pneumonia the develops 48 hours after hospitalization
HAP includes what 3 types of pneumonia?
most common?
-
1. Ventilator-associated pneumonia **
- MC and affects intubuated pts 48 hrs after endotracheal intubation
- 2. Non-ventilator assx pneumonia
- 3. Post-operative pneumonia
MCC of HCAP?
Microaspiration of bacteria that colonize the oropharyx and upper airways in seriously ill patients
- Gram (-) baccilli
- S. aerus
Greatest overal risk of HCAP?
Endotracheal intubation with mechanical ventilation
What reduces risk of HCAP?
- Avoid intubation
- Prompt intubation, if needed.
Other ways to prevent infection and HCAP?
- Wash hands
- While intubating patiens, they should be upright or semi-upright to decrease aspiration
- Mough care
How can we dx VAP?
- CP
- leukocytosis
- new or changing radiographic finnings
- decline in oxygenation
If person is suspected to have VAP, what is the first thing we do?
GIVE ABX (pick based on risk of multi-drug resistant pathogens; prolong duration of hospitalization (5 or more days) , admission from health-care related facility, recent prlonged ABX therapy)
do not delay for diagnositc testing.
Patients with no risk factors of VAP should be treated with ______.
W/ risk factors _______
- No risk factors: ceftriaxone or levofloxacin
- Risk factors: antipseudomonal agent or vancomycin
